ASSISTED LIVING ADMINISTRATORS’ UNDERSTANDING OF REGULATORY REQUIREMENTS IN SEVEN STATES

Abstract Each state requires assisted living (AL) residences to employ an administrator whose job responsibilities include oversight of resident care, managing staff, and regulatory compliance. This study surveyed administrators of 151 AL residences in 7 states. These AL residences reflect 28 license types (e.g., based on level of care, dementia care services). Administrators were asked whether there were any regulations, policies or procedures that required their AL to do any of 11 health-related activities (e.g., staff able to check vital signs, advance directive on file, reporting change in condition to resident’s healthcare provider). Using health services regulatory analysis, we documented the applicable regulations for each of the 151 AL residences, then assessed whether administrator responses were congruent with the licensed requirements. Almost all (95%) administrators of AL residences governed by a licensure requirement regarding change in condition reported this policy in their residence. In contrast, less than half (48%) of administrators who work in an AL in our sample that state law requires to keep an advance directive on file for residents reported that they did not have a policy to do so. Over one-third (37%) of administrators who work in an AL required to have a policy of non-pharmaceutical treatment for residents with dementia said that they did not have this policy in place. Some administrators reported the presence of policies in the absence of state requirements, suggesting that these AL residences exceed minimum requirements. These results vary by AL license type both within and across states.

of 250 AL communities in 7 states and a database of AL regulations, we employed bivariate analysis and multilevel linear probability models to examine regulatory and organizational correlates of AL community admissions and discharge practices for three activities of daily living (ADLs [bathing, getting out of bed, and eating]).There was a pattern between admissions regulation and admissions practices in AL; for example, 38% of communities with license types that had the most flexible admissions regulations allowed residents with feeding limitations to be admitted; conversely, 18% with the least flexible regulations allowed them to be admitted.However, the relationships were not statistically significant in bivariate or multivariate analysis.A higher percent of residents with Medicaid as a primary payer source was associated with a decrease in the probability of admitting ( = -0.01,p<.001, 95% confidence intervals [CI]: -0.01, 0.00) and discharging ( = 0.01, p=.013, 95% CI: 0.00, 0.01) residents with bathing limitations.Being operated in association with a continuing care retirement community or nursing home was associated with a higher probability of discharging residents who needed assistance with bathing ( = 0.14, p=.013, 95% CI: 0.03, 0.26) and more so with feeding ( = 0.26, p <.001, 95% CI: 0.15, 0.36).Findings suggest a need to consider whether models of AL and AL practices could better align with the residents' needs.
Each state requires assisted living (AL) residences to employ an administrator whose job responsibilities include oversight of resident care, managing staff, and regulatory compliance.This study surveyed administrators of 151 AL residences in 7 states.These AL residences reflect 28 license types (e.g., based on level of care, dementia care services).Administrators were asked whether there were any regulations, policies or procedures that required their AL to do any of 11 health-related activities (e.g., staff able to check vital signs, advance directive on file, reporting change in condition to resident's healthcare provider).Using health services regulatory analysis, we documented the applicable regulations for each of the 151 AL residences, then assessed whether administrator responses were congruent with the licensed requirements.Almost all (95%) administrators of AL residences governed by a licensure requirement regarding change in condition reported this policy in their residence.In contrast, less than half (48%) of administrators who work in an AL in our sample that state law requires to keep an advance directive on file for residents reported that they did not have a policy to do so.Over one-third (37%) of administrators who work in an AL required to have a policy of non-pharmaceutical treatment for residents with dementia said that they did not have this policy in place.Some administrators reported the presence of policies in the absence of state requirements, suggesting that these AL residences exceed minimum requirements.These results vary by AL license type both within and across states.

AUTONOMIC ACTIVITY AND THE AGING BRAIN Chair: Mara Mather
Aging affects both autonomic activity and the brain regions that help modulate autonomic activity.In this symposium, we present new findings on how the relationships between autonomic activity and the brain change in aging.In addition, we demonstrate that modulating autonomic activity can affect the aging brain and emotional and cognitive functions controlled by the brain.Kathy Liu will present research from over 600 participants showing that, unlike younger adults who show the expected positive relationship between heart rate variability (HRV) and brain and behavioral indicators of emotion regulation, older adults showed a negative relationship between HRV and emotion regulation.Julian Thayer will present findings on how blood pressure and total peripheral resistance relate to brain structure.Richard Song will present functional MRI data revealing that the older brain shows less blood oxygen level dependent (BOLD) response to physiological fluctuations than younger brains.Jungwon Min will present findings that random assignment to daily biofeedback to either increase or decrease heart rate oscillations had a large effect on plasma amyloid-β.Mara Mather will present a new theoretical model positing that older brains attempt to compensate for hyperactive peripheral sympathetic activity, and that this ventromedial prefrontal compensatory activity leads to the biases in attention and memory known as the age-related positivity effect.Together, the empirical findings and theoretical perspectives presented in this symposium indicate that the autonomic system exerts important influences over the aging brain and that this provides a significant opportunity for intervening to improve brain health.

THE AGING BRAIN: A NEUROVISCERAL INTEGRATION PERSPECTIVE
Julian Thayer, University of California, Irvine, Irvine, California, United States Healthy aging is associated with significant changes in both the brain and the heart.The changes between these, the two most important organs of the body, are linked via the vagus nerve.Using a model of Neurovisceral Integration I will describe how autonomic imbalance and decreased parasympathetic tone in particular may be the final common pathway linking negative affective states and conditions to ill health.The central nervous system network that regulates autonomic balance is closely related and partially overlaps with networks serving executive, social, affective, cognitive, and motivated behavior.This inhibitory cortico-subcortical circuit may structurally as well as functionally, link psychological processes with health-related physiology.When the prefrontal cortex is taken "offline" for whatever reason, parasympathetic inhibitory action is withdrawn and a relative sympathetic dominance associated with disinhibited defensive circuits is released, which can be pathogenic when sustained for long periods.This state is indicated by low heart rate variability (HRV), which is a marker for low parasympathetic activation and prefrontal hypoactivity.In this presentation, I examine the normative changes with aging and the effect that stress may have on how the brain-heart connection changes with age.I will present data linking peripheral physiology to brain structure and function.I conclude by noting that significant sex and ethnic differences exist but that future studies are needed to more fully explicate how they may influence the aging brain and its association with the cardiovascular system.

DIFFERENT ASSOCIATIONS BETWEEN HEART RATE VARIABILITY AND EMOTION REGULATION IN OLDER AND YOUNGER ADULTS Kathy Liu, University College London, London, England, United Kingdom
Heart rate variability (HRV), the beat-to-beat variation in heart rate, is proposed to index aspects of self-regulatory processes such as emotion regulation.This is due to overlapping neural regions and networks that contribute to the central autonomic and emotion regulation systems.Paradoxically, increasing age is associated with both improvement in emotion regulation and decline in HRV, and it is unclear whether and how the association between HRV and emotion regulation is influenced by aging.The earliest stages of neurodegenerative processes, such as Alzheimer's disease-related reduction of locus coeruleus (LC) integrity, may also influence the HRVemotion regulation relationship in older adults, as LC modulates arousal and autonomic activity in response to stress.We pre-registered a study to investigate the cross-sectional relationship between measures of emotion regulation, HRV and